Comparing Spontaneous Closure and Paper Patching in Traumatic Tympanic Membrane Perforations

Abstract

The authors aim to analyze the effects of oral antibiotic treatment for traumatic tympanic membrane perforations and to compare the outcomes of patients with traumatic tympanic membrane perforation after paper-patching procedure and spontaneous healing. In this study, 80 patients with traumatic tympanic membrane perforation diagnosed in the otorhinolaryngology emergency department and outpatient clinic from March 2010 to January 2015 were retrospectively reviewed. If the patient is diagnosed at first week and the edge of perforation is moist with blood, our routine procedure is paper-patching (group 1). However, if the patients reject treatment or delay in admission, the authors follow up patients for spontaneous closure (group 2). Some of the patients got oral antibiotics for 7 days (amoxicillin/clavulanic acid, 1000 mg 2 times/d) while some others did not. Closure rates and effectivity of oral antibiotics were evaluated and compared between 2 groups. In total, 80 patients were analyzed. The closure rates of perforations were 95.2% for group 1 (n = 42) and 81.6% for group 2 (n = 38). Although the paper-patched patients (group 1) perforation closure rate (95.2%) is higher than the nontreated patients (group 2) closure rate (81.6%), it is not statistically significant (P > 0.05). Antibiotic administered 55 patients had a significantly higher closure rate (94.5%) than the 25 patients who are not treated with antibiotics (76%) (P = 0.023; P < 0.05). In patients with traumatic tympanic membrane perforations, spontaneous closure rate is quite high. This study showed us that antibiotherapy and paper-patch treatments increase the healing rates.

A Systematic Review of Nonautologous Graft Materials Used in Human Tympanoplasty

“…In two studies, the use of platelet‐derived growth factors with paper patching produced equivalent closure rates and hearing outcomes as compared to paper patch alone 15,29 . Furthermore, eight studies found higher closure rates in patients treated with paper patch (91.6%) than patients being observed for spontaneous closure (78.8%, P < .001) 14,21,23,25,31–34 . Reported outcomes of spontaneous closure consistently showed a longer duration for complete TM healing but similar postoperative audiometric outcomes when compared to paper‐patch grafting 14,21,25 …”

“…Twenty‐two studies reported outcomes of paper patches for repair of TM perforations 13–34 . Several different types of paper were utilized, including rice paper, cigarette paper, and paper patch (not otherwise specified).…”

“…15,29 Furthermore, eight studies found higher closure rates in patients treated with paper patch (91.6%) than patients being observed for spontaneous closure (78.8%, P < .001). 14,21,23,25,[31][32][33][34] Reported outcomes of spontaneous closure consistently showed a longer duration for complete TM healing but similar postoperative audiometric outcomes when compared to paper-patch grafting. 14,21,25 Patching Materials: Silk Fibroin Silk fibroin, a natural polymer with long-term degradation characteristics (up to 16 months), has also been studied for TM repair in humans.…”

“…Ten publications 13,[15][16][17][18][19][24][25][26][27] mentioned additional edge trimming in the procedure methodology. When sorted by perforation etiology, we found lower closure rates for perforations caused exclusively by otitis media (three articles, 20,26,29 range, 10.0%-52.2%) versus trauma (11 articles, [14][15][16][21][22][23]25,[31][32][33][34] range, 80.0%-95.2%). Weighted averages showed that closure rates were lower for perforations secondary to otitis *Does not reflect summation of column.…”

“…15,16,[20][21][22]26 Several studies compared outcomes from paperpatch grafting to various control groups, including autologous perichondrium, adipose tissue (fat plug), plateletrich fibrin membranes, and spontaneous TM healing. 14,15,17,21,25,[31][32][33][34] Dursun et al 17 demonstrated that tympanoplasty with perichondrium or adipose tissue showed a relatively higher average closure rate and improved ABG (87.7%, 5.4 ± 0.8 dB, respectively) when compared to paper-patch grafting (66.7%, 8.4 ± 2.2 dB, respectively); however, the small sample size of 15 patients may have contributed to the inability to reach statistical significance. In two studies, the use of plateletderived growth factors with paper patching produced equivalent closure rates and hearing outcomes as compared to paper patch alone.…”